- 期刊
- OpenAccess
Palliative Treatment of Malignant Biliary Obstruction Using Self-expandable Metallic Stents: Long-term Clinical Results
使用能自行擴張的金屬支架來緩解惡性膽道阻塞：長期臨床結果
摘要
本研究乃是用來評估用能自行擴張的金屬支架來緩解惡性膽道阻塞的臨床效果。42個病人共使用了48個金屬支架（包括11個胰臟癌，9個膽管癌和7個壺腹癌，4個總膽癌2個膽囊癌及9個腫瘤轉移的病人），16個病人(36%)之前曾接受肝、胃的手術。其中15個病人(33%)得到病理證實。最初幾乎所有的病人都接受了經皮穿肝膽道引流，只有3個病人是開刀時安裝了T型管於總膽管。所有病人支架的安裝都很成功。38個病人(84%)只有用了一個支架；6個病人(13%)使用了2個支架，而只有1個病人(2%)用了3個支架；3個病人從兩側放置支架，而26個情形則是將支架穿過壺腹一側一直到十二指腸，有2個病人在放完支架24小時內發生短暫的急性胰臟炎，有4個人發生疼痛現象，但給予內科治療後症狀就緩解，有3個病人裝置後1-3個月發生慢性膽囊炎，需要再一次處理膽道阻塞的情形只有20%（9個病例）：其中包括4例經皮穿肝膽道引流，2例經皮穿肝膽囊引流及4例用內視鏡式逆行性胰膽引流。
並列摘要
This study is conducted to evaluate the clinical efficacy of different self-expandable metallic stents for palliative treatment of malignant biliary obstruction. The pros and cons of each stent design were compared. Forty-eight self-expandable metallic stents were used in 42 patients (pancreatic cancer, n=11; cholangiocarcinoma, n = 9; ampulla of Vater cancer, n = 7; common bile duct cancer, n = 4; gallbladder cancer, n = 2; metastases, n = 9). Sixteen patients (38%) had previously undergone hepato-biliary and gastric surgery. Pathologic confirmation as malignant was done in 15 patients (36%). All patients underwent percutaneous transhepatic biliary drainage except three patients who had a matured T-tube tract placed during surgery. Stent placement was successful in all patients. Thirty-five patients (85%) were treated with a single stent, while six (15%) needed two stents. One patient had bilateral drainage and twenty-two had stents crossing the ampulla of Vater. Two patients had transient acute pancreatitis and four patients had right upper quadrant abdominal pain, which subsided after conservative treatment. Three patients had cholecystitis after prostheses placement. The re-intervention rate was 24% (n = 10) as follows: percutaneous transhepatic biliary drainage n = 4; percutaneous transhepatic gallbladder drainage n = 2; endoscopic retrograde cholangiography n = 4. Overall stent patency ranged from 3 to 780 days (mean, 183 days), with mean survival of 184 days. In conclusion, our results show that the use of metallic stents is effective in the palliation of obstructive jaundice. The newly developed Memotherm self-expanding, non-shortening metallic stent is easier to insert accurately.